Provider Demographics
NPI:1104128552
Name:KURTZ, JASON MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MATTHEW
Last Name:KURTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 E YORBA LINDA BLVD
Mailing Address - Street 2:STE 209
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870
Mailing Address - Country:US
Mailing Address - Phone:714-831-1844
Mailing Address - Fax:714-831-1845
Practice Address - Street 1:1041 E YORBA LINDA BLVD
Practice Address - Street 2:STE 209
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:714-831-1844
Practice Address - Fax:714-831-1845
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine